Week 8 Study Guide Flashcards
Essential Terms
-AIDS-defining conditions= serious diseases that occur in HIV+
-Antiretroviral therapy (ART)= interferes with HIV being able to reproduce itself
-Immune reconstruction Inflammatory reconstruction (IRIS)= inflammatory disorders that are worsening of infectious processes following ART
-Opportunistic infection= infections that occur more often in people with weakened immune systems
-Seroconversion= when HIV antibodies are produced and test from negative to positive, within a few weeks
-Serodiscordant= one partner HIV+ other is HIV-
-Viral load= the amount of virus in an infected persons blood
-Viral set point= viral replication is still taking place but immune system is unable to destroy the virus in equal amounts as its being produced
Human Immunodeficiency Virus (HIV)
- Hijacks the body’s own immune system for viral replication, eventually kills patients R/T opportunistic infections arising from weakened immune system
- Been around sine early 80’s
- Risk factors in order of incidence: unprotected sexual contact, IV drug usage, mother/child in pregnancy, occupational exposure (not common), blood transfusion
- If you get a needle stick: wash the area under running water with out squeezing it, permission from patient for lab tests to determine their viral status, post-exposure prophylaxis
How HIV Enters the Body
1- Viral transmission = virus gets in to body
2- Acute viral infection= HIV cells are engulfed by our bodies CD4 cells and then HIV cells take over
3- Seroconversion= it is there to stay
4- Asymptomatic chronic infection
5- Symptomatic chronic infection
6- AIDS
7- Death via opportune infections
HIV Co-morbidities
-TB
-Malaria
-Malnutrition
-Co-morbidities makes the process move faster
-Untreated patients have a 12 year life span
Prevention better than Treatment
- Education
- Safe sex
- PrEP
- Screening
- High risked individuals should be screened yearly
- Men having sex with men (MSM)
- People coming to STI clinic
- incarcerated
- Routine screening SHOULD be offered for everyone
Labs to Monitor for Patients with HIV
- CD4 lymphocytes and viral load
- Goal with treatment: More CD4 and less viral load. Signs of worsening will have less CD4 and more viral load
Stages of HIV Disease
(2 questions)
- HIV stage 1= > 500 CD4 cells
- HIV stage 2= 200-499 CD4 cells
- HIV stage 3 (AIDS)= < 200 CD4 cells
Management of HIV+ Patient
- Monitor vial load and CD4 every 3-6 months until fully established on medication regimen
*If CD4 <200, then drawn monthly and prophylactic ABX started, can be stopped when CD4 is >200 for 3 months in a row - Monitor TB test every 6 months
- Medication: Antiretroviral Therapy (ART)
* Minimum of 3 different drugs from 2 different classes. ** Hepatic and renal function must be monitored prior to starting and periodically during therapy *** Adherence rate needs to be >/=95% to achieve viral load of zero ** Therapy is lifelong
Management of HIV+ Patient (cont.)
- Immunizations (need to stay up to date, NO live vac.): *Live= MMR, Chicken Pox (Varicella), rotavirus, small pox, polio ORAL **Inactivated/dead= Flu, polio SHOT, Covid, Hep A, HPV, DTaP
- Complications include opportunistic Infections (OI) = viral, bacterial, fungal, parasitic?
-AIDS-defining illnesses:
*Pneumocystitis Carinii Pneumonia (PCP)- SOB, dyspnea, cough, fever
*Mycobacterium Avium (tuberculosis)- night sweats, cough, fever
*Toxoplasmosis- fever, headache, fatigue
Complications of HIV
- Opportunistic Infections (OI)
- AIDS- defining illnesses
- Pneumocystitis Carinii pneumonia (PCP): SOB, dyspnea, cough, fever,
- Mycobacterium Avium: Night sweats, cough, fever
- Toxoplasmosis: Fever, headache, fatigue
-S&S of deterioration: FEVER, new onset cough, increased fatigue, night sweats, new onset headache, new skin lesions, weight loss
Bactrim and HIV
(2 questions)
- Do not administer Bactrim to HIV +
- Causes a short delayed allergic reaction that causes hemolytic anemia - blood transfusion reaction/ body starts destroying itself.
- S&S: weak, pale, fatigue, increase HR, less oxygen, hypotension, increase respiration, low H&H
In- hospital Precautions for an HIV+ Patient
(2 questions)
- Standard precautions / all patient care
- Infection control practices to prevent transmission of disease that is acquired by blood, body fluids, non-intact skin like rashes, and mucous membranes
- hand hygiene, PPE as needed, sharps safety,
STD ESSENTIAL TERMS
- Atypical= abnormal cells
- Colposcopy= examines cervix, vagina, and vulva
- Cytolysis= disruption of cells by an external agent
- Cytology= single cell exam to diagnose cancer, screen fetal abnormalities, pap smears
- Epididymitis= inflammation of the small coiled tube at the back of the testicle (swollen or red scrotum, testicle pain)
- Fitz-Hugh-Curtis Syndrome= chronic pelvic inflammatory disease (PID)
- Incubation period= time when infection occurred to the onset of signs and symptoms of the first positive test
- Lymphadenopathy= swelling of lymph nodes that is 2nd to bacterial, viral, or fungal infections
- Obligate intracellular bacterium= require a eukaryotic host to survive and replicate
-Pathogenesis= development of a disease - Prodromal= from the start of symptoms to the development off rash or fever
- Reiter’s Syndrome= common inflammatory polyarthritis in young men
- Salpingitis= inflammation of the fallopian tubes caused by bacterial infection
- Subclinical= disease that has not progressed enough to show observable symptoms
-Urethritis= inflammation of the urethra - Dysuria= painful urination
- Dyspareunia= painful intercourse
STDs Background Info
- Tell infected patients to tell their partners
- Be tested, have partners tested
- Utilize safe sex practices: condoms, monogamy, abstinence, vaccination, communicate with partner, do not use drugs and alcohol
- (birth control and STD prevention are different)
- Many STDs are commonly asymptomatic
- Many STDs spread more easily from man to women than vice versa
Human Papillomavirus (HPV)
- Most sexually active people who aren’t vaccinated against HPV will become infected at some point in their lives
- There are two varieties; oncogenic and non-oncogenic
Non-Oncogenic
- appearance of genital warts that are painless- little pain, uncomfortable, itchy
- Can be treated with creams or gels, or removed by a physician with cryotherapy.
- Can cause an issue in pregnancy but you also cannot use cream or gels while pregnant,
- May have to have a c-section due to warts occluding birth canal
Oncogenic = tumor formation
- No to little symptoms
- Can cause morphological changes to infected cells over time. AKA cancerous changes
- An average of 90% of people clear their infections over time
- Infections that do not clear up can increase chances of cancer in the affected area: cervical, vaginal, penile, oropharyngeal, anal
Treatment for the oncogenic strains
- Ablation: freezing or burning abnormal tissue
- Excision: cutting off abnormal tissue
- Loop Electrosurgical Excision (LEEP): electrically heated loop of wire to remove abnormal tissue
- Laser Conization: laser light to remove abnormal tissue
- Vaccinations exists for both men and women > can reduce cervical cancer rates by 90%
HPV and Cancer
- Cervical Cancer: only cancer caused by HPV that has a recommended screening test to detect it an early stage = 11,000 cases a yr
- Cervical Pre-cancers: screenings can detect pre-cancers before they turn into cancer, treatment for pre-cancers can lead to problems during pregnancy = 196,000 cases a yr
- Other Cancers Caused by HPV: no recommended screening tests, may not be detected until they cause serious health problems > 14,000/ back of throat, 6,500/ anus, 2,800/ Vulva, 900/ penis, 700/vagina
- HPV vaccination during age 11-12 could prevent over 90% of these cancers
Syphilis
-Epidemiology: after dropping rapidly in the in the 1940’s after Penicillin was developed, it’s on the rise around the world again related to HIV. 105,000 deaths worldwide in 2015
- Spread by sexual contact, caused by bacteria called Treponema Pallidum
Syphilis S&S, Diagnosis, and Treatment
S&S:
- skin lesion at point of infection called a chancre, can become an area of ulceration
- followed by lymphadenopathy and a skin rash on the palms, soles of feet, and trunk
- Untreated syphilis can then become systemic, effecting CNS, cardiovascular, etc
Diagnosis: testing of blood or fluid collected from chancres and ulceration areas
Treatment: A single dose of Penicillin
Herpes Simplex Virus (HSV)
- Chronic viral infection (1:5 Americans)
- 2 main variants:
*HSV1: mostly oral-oral route. Cold sores.
Can lead to genital herpes. More prevalent
in America
*HSV2: mostly genital-genital route, more
prevalent worldwide - No cure for HSV; outbreak/remission, after 1st infection, there will be at least one outbreak in more than 75% people, some who have an outbreak 6+ times a year
- Easily transmitted to women from men than vice versa
-Risk Factors: unprotected sex/many partners, MSM, history of STI’s, incarceration, <25, unmarried,
HSV S&S
- One or many clear, fluid filled vesicles (blisters) in the genital area
- Vesicles then rupture, forming open ulcerations that can last 2-4 weeks without treatment
- Painful, itching, burning associated with vesicles and ulcerations
- Symptoms more severe in women
- Symptoms preceded by a prodromal phase: an abnormal sensation prior to outbreak: tingling, itching, burning
- Can have systemic symptoms with vesicles eruption
*Fever, headache, dysuria, myalgia (muscle pain/soreness), swollen lymph nodes in groin, burning/tingling
HSV Treatment
- Antiviral medications such as Acyclovir
- Suppresses the infection, provides symptom relief
- Most useful when taken early in the outbreak * Teach patients to seek treatment when that prodromal stage is noted, PRIOR to vesicle eruption
- Patients with more than 6 outbreaks a year may be put on suppressive therapy, constant daily antiviral therapy to prevent outbreaks
- Symptom Management: warm salt baths to dry up lesions and ease pain/discomfort of vesicles, ice to affected area, loose-fitting clothing